title: Outcome of regional lymph node dissection in conjunction with laparoscopic nephroureterectomy for urothelial carcinoma of the upper urinary tract.
abstract: OBJECTIVE
  To obtain accurate disease staging, we routinely perform regional lymph node dissection (LND) in conjunction with laparoscopic nephroureterectomy (NU) to treat urothelial carcinoma of the upper urinary tract. The present study evaluated the feasibility and usefulness of LND in laparoscopic NU.
  
  
  METHODS
  Thirty-nine patients undergoing laparoscopic NU with regional LND were included in the present study. We evaluated the number of lymph nodes (LNs) resected, pathological node status, adverse events, and survival data. Node count was compared with that of 41 patients who underwent open NU between 1990 and 2008.
  
  
  RESULTS
  The median number of LNs removed was 10 (range, 2-59) in the laparoscopic NU group and 10 (range, 1-65) in the open NU group (Mann-Whitney U-test, p = 0.82). Pathological examination demonstrated positive LNs in four patients (10.3%) and three of the four patients received adjuvant chemotherapy. Although chylous drain discharge was detected just after resuming dietary intake in eight patients, it resolved without significant problem. Five-year overall survival by stage was 100% for pT2 ≥ disease, 55% for pT3 disease, and 0% for pT4 disease.
  
  
  CONCLUSIONS
  LND can be performed safely and effectively during laparoscopic nephroureterectmy. We consider that accurate node staging and subsequent stratification are mandatory for disease management.
authors.affiliation: Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. takataka@rf6.so-net.ne.jp
authors.forename: Takashige
authors.initials: T
authors.lastname: Abe
authors.forename: Toru
authors.initials: T
authors.lastname: Harabayashi
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shinohara
authors.forename: Ataru
authors.initials: A
authors.lastname: Sazawa
authors.forename: Satoru
authors.initials: S
authors.lastname: Maruyama
authors.forename: Hajime
authors.initials: H
authors.lastname: Sasaki
authors.forename: Katsuya
authors.initials: K
authors.lastname: Nonomura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000601:surgery*; D019459:Urothelium / Q000473:pathology* / Q000601:surgery*